Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem - Para.

OBJECTIVE: to assess the socioeconomic and demographic profiles of patients hospitalized with a diagnosis of diabetic foot in a tertiary hospital in Belem-PA, Brazil, as well as to evaluate risk factors for lower limb amputations in such patients, classifying them according to the Wagner and PEDIS classifications. METHODS: we conducted a descriptive, cross-sectional, unicentric, and analytical study carried out through a structured questionnaire. RESULTS: the study consisted of 57 patients, aged between 48 and 84 years old, 66.7% being male. The average income ranged between one and three (61.4%) minimum wages and below one minimum wage (31.6%). Type II Diabetes Mellitus was predominant (86.0%). Concerning comorbidities, arterial hypertension displayed the highest proportion (62.3%), followed by dyslipidemia (52.8%). Smokers comprised 35.1% of the sample. Infectious diabetic foot (50.9%) and mixed diabetic foot (49.1%) were the most common. Of the 20 patients with previous amputation, 90% had undergone minor amputation, and 10%, major ones. Callosity (92.6%) was the most prevalent deformity. Fifty-four (94.7%) patients underwent surgery, those being debridement (24.1%), minor amputation (37.0%) and major amputation (38.9%). During hospitalization, 78.9% of individuals did not require ICU stay. Hospitalization time varied between three and 59 days, and 78.9% of hospitalized patients did not progress to death, but 43.1% of patients submitted to major amputations died. CONCLUSION: patients with diabetic foot followed-up have a low socioeconomic profile; most of them underwent surgical procedures, whether major or minor, due to the higher prevalence of infectious diabetic foot and/or non-adherence to non-operative treatment.

Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem - Para / Perfil socioeconômico e demográfico de pacientes internados por complicações nos pés diabéticos em um hospital terciário em Belém - Pará

ABSTRACT Objective: to assess the socioeconomic and demographic profiles of patients hospitalized with a diagnosis of diabetic foot in a tertiary hospital in Belem-PA, Brazil, as well as to evaluate risk factors for lower limb amputations in such patients, classifying them according to the Wagner and PEDIS classifications. Methods: we conducted a descriptive, cross-sectional, unicentric, and analytical study carried out through a structured questionnaire. Results: the study consisted of 57 patients, aged between 48 and 84 years old, 66.7% being male. The average income ranged between one and three (61.4%) minimum wages and below one minimum wage (31.6%). Type II Diabetes Mellitus was predominant (86.0%). Concerning comorbidities, arterial hypertension displayed the highest proportion (62.3%), followed by dyslipidemia (52.8%). Smokers comprised 35.1% of the sample. Infectious diabetic foot (50.9%) and mixed diabetic foot (49.1%) were the most common. Of the 20 patients with previous amputation, 90% had undergone minor amputation, and 10%, major ones. Callosity (92.6%) was the most prevalent deformity. Fifty-four (94.7%) patients underwent surgery, those being debridement (24.1%), minor amputation (37.0%) and major amputation (38.9%). During hospitalization, 78.9% of individuals did not require ICU stay. Hospitalization time varied between three and 59 days, and 78.9% of hospitalized patients did not progress to death, but 43.1% of patients submitted to major amputations died. Conclusion: patients with diabetic foot followed-up have a low socioeconomic profile; most of them underwent surgical procedures, whether major or minor, due to the higher prevalence of infectious diabetic foot and/or non-adherence to non-operative treatment.

RESUMO Objetivo: traçar o perfil socioeconômico demográfico de pacientes internados com diagnóstico de pé diabético em um hospital terciário de Belém-PA, bem como avaliar os fatores de riscos para amputações de membros inferiores classificando-os de acordo com os critérios de Wagner e PEDIS. Métodos: estudo descritivo, transversal, unicêntrico e analítico realizado mediante questionário estruturado com perguntas objetivas e com posterior análise estatística descritiva de pacientes diagnosticados com pé diabético em um hospital terciário de Belém-PA. Resultados: estudo foi composto por 57 pacientes, com idade variando entre 48 e 84 anos, sendo 66,7% masculino. A renda medida oscilou entre 01 a 03 salários. O Diabetes Mellitus do tipo II foi predominante (86,0%). HAS foi a doença associada mais prevalente (62,3%), seguida da Dislipidemia (52,8%). Havia 35,1% fumantes. O tipo mais comum de pé diabético foi o neuropático (59,6%), seguido pelo infeccioso (50,9%) e o misto (49,1%). O tempo de hospitalização variou entre 03 e 59 dias. 43,1% dos pacientes que foram submetidos a amputações maiores faleceram. Conclusão: a ocorrência de pé diabético foi maior nos pacientes do sexo masculino com mais de 50 anos de idade. Predominaram pacientes de baixa renda e com pouca escolaridade. A maioria dos pacientes foram acometidos por pé diabético do tipo II e padrão infeccioso e, que necessitaram de intervenção. A maioria dos pacientes foi admitido com classificações mais avançadas de Wagner e PEDIS, o que estava associado à altas taxas de amputações, impactando nos desfechos de mortalidade.

Aspectos epidemiológicos de pacientes com lesões iatrogênicas das vias biliares / Epidemiological aspects of patients with iatrogenic biliary

Objetivo: avaliar os aspectos epidemiológicos de pacientes com lesões iatrogênicas das vias biliares no Serviçode Cirurgia Geral e do Aparelho Digestivo do Hospital Universitário João de Barros Barreto nos últimos 10 anos.Método: estudo transversal e retrospectivo dos prontuários de 25 pacientes com diagnóstico de lesão iatrogênica davia biliar. Foram incluídos pacientes oriundos do próprio serviço e de outras instituições. O período foi de janeirode 1999 a dezembro de 2008. Resultados: foram encontrados 25 casos de lesões iatrogênicas das vias biliares,sendo 22 consequentes de colecistectomias convencionais. Um total de 56% foi procedente de outras instituições. Asmanifestações clínicas mais prevalentes: dor abdominal (88%), icterícia (76%) e colúria (56%). O tempo de evoluçãodos sintomas variou desde 1º pós-operatório até 168 meses (14 anos). Cerca de 16% apresentavam diagnóstico decolangite no momento da internação. O método de diagnóstico mais utilizado foi a colangiopancreatografia retrógadaendoscópica (48%), seguida da colangiorressonância (28%). As estenoses classificadas como Bismuth II foramas mais encontradas (40%), seguidas de Bismuth III (32%). A cirurgia corretiva foi a hepático-jejunoanastomoseem Y de Roux (92%). As lesões vasculares foram as principais complicações intra-operatórias. O tempo médiode internação foi de 21dias. Conclusão: a maioria dos casos de iatrogenias foi proveniente de colecistectomiasconvencionais, realizadas em centros não especializados em cirurgia de vias biliares. O respeito ao rigor técnico dacirurgia permanece sendo medida preventiva mais eficaz para a diminuição da incidência de iatrogenias das viasbiliares

Objective: to evaluate the epidemiological aspects of iatrogenic injuries of bile ducts of patients seen in generalsurgery service and the digestive system of the University Hospital João de Barros Barreto in the last 10 years.Method: we performed an observational study, the type of retrospective medical records of patients with iatrogenicinjury of the biliary tract. We included patients from the service itself and other institutions. The variables studiedwere sex, age, origin, clinical manifestations, presence of cholangitis, time course, diagnostic method used, surgerythat caused the injury, surgery for the correction, the second Bismuth classification of the lesion, intraoperativecomplications surgery and hospital stay. Results: we found 25 cases of iatrogenic biliary tract, with 22 resulting fromconventional cholecystectomy. A total of 56% came other institutions. The female sex was more prevalent (80%), theaverage age of patients was 43 years. The most prevalent clinical manifestations: abdominal pain (88%), jaundice(76%) and dark urine (56%). The duration of symptoms ranged from 1 postoperative day up to 168 months (14years). About 16% had a diagnosis of cholangitis at admission. The method most frequently used is the endoscopicretrograde cholangiopancreatography (48%), followed by magnetic resonance cholangiography (28%). The stenosesclassified as Bismuth II were the most frequent (40%), followed by Bismuth III (32%). Corrective surgery washepatic-jejunoanastomose Roux-Y (92%). Vascular lesions were the major intraoperative complications. The meanhospital stay was 21 days. Conclusion: most cases of iatrogenic injuries came from conventional cholecystectomyperformed in centers not specialized in surgery of the biliary tract. Respect for the technical accuracy of the surgeryremains the most effective preventive measure for reducing the incidence of iatrogenic injuries of bile ducts.